P-008 Neoadjuvant treatment in gastric adenocarcinoma

Abstract

Introduction: Gastric cancer represents the second leading cause of cancer death worldwide and is the fourth most common malignancy in the world. Several studies evaluated the use of neoadjuvant chemotherapy in gastric cancer that demonstrated a survival benefit using both pre-operative and post-operative chemotherapy. Nevertheless, the delivery of post-operative chemotherapy was generally suboptimal due to patients' poor tolerance. In this abstract we review neoadjuvant (or peri-operative) therapies in resectable gastric adenocarcinoma. Methods: It was a retrospective study of 29 gastric adenocarcinoma patients who received neoadjuvant or peri-operative between 2011 and 2014 at Rouiba Medical Oncology Department. Median age was 57 years, 10 women with a median age 49 years [26-66] and 19 men with a median age of 61 years [37-76]. Results: In the 29 patients the primary tumor was located in the stomach and in the gastro-oesophageal junction in 22 (75%) pts and 7 pts (25%) respectively and confirmed histologically by biopsy. Median time of diagnosis was 3.7 months. All patients received chemotherapy before surgery, the regimens used were: EOX (epirubicin, oxaliplatin, capecitabine) in 16 pts (55%), docetaxel plus cisplatin in 07 pts (25%), TPF (docetaxel, cisplatin, 5FU) in 03 pts (10%) and 03 pts (10%) received Capox (capecitabine, oxaliplatin). In the 16 pts who received EOX (epirubicin 50mg/m2, oxaliplatin 85mg/m2 and capecitabine 625mg/m2 BID and continuously), the median number of cycles before surgery was 3 cycles (Day 1= Day 21). All patients were assessed by CT scan before surgery: 7 partial response (43%), 05 stable disease (31%), 1 patient presented liver metastases, and 03 pts were under investigation at the time of this study. In the 12 pts who presented PR or SD only 09 pts underwent surgery (04 total gastrectomy plus D2 lymph node dissection, 03 4/5 gastrectomy + D2, 01 oesophagectomy + D2 and 01 presented peritoneal carcinosis per-operatively). Only 06 patients were able to complete EOX post-operatively, and median RFS (relapse free survival: time of surgery to relapse) was 08 months with a median follow up of 12 months. In the 29 pts 13 were able to undergo surgery and independently of the chemotherapy regimen received the median RFS was 7.5 months with a median follow up of 12 months. No death was recorded in this series. Conclusion: In this series 8 pts (27%) were able to complete the peri-operative chemotherapy regimen, and statistically median RFS was equivalent independently of the chemotherapy regimen used.